RESUMO
BACKGROUND & AIMS: Liver ultrasound (US) is usually used in the clinical setting for the diagnosis and follow-up of patients with nonalcoholic fatty liver disease (NAFLD). However, no large study has carefully assessed its performance using a semiquantitative ultrasonographic scoring system in overweight/obese patients, in comparison to magnetic resonance spectroscopy ((1) H-MRS) and histology. METHODS: We recruited 146 patients and performed: a liver US using a 5-parameter scoring system, a liver (1) H-MRS to quantify liver fat content, and a liver biopsy to assess histology. All measurements were repeated in a subgroup of patients (n = 62) after 18 months of follow-up. RESULTS: The performance of liver US (parenchymal echo alone) was rather modest, and significantly worse than (1) H-MRS (AUROC: 0.82 [0.69-0.94] vs. 0.96 [0.90-1.00]; P = 0.04). However, the AUROC improved when different echographic parameters were taken into account (AUROC: 0.89 [0.83-0.96], P = 0.15 against (1) H-MRS). Optimum sensitivity for liver US was achieved at a liver fat content ≥12.5%, suggesting that below this threshold, liver US is less sensitive. Liver (1) H-MRS showed a high accuracy for the diagnosis of NAFLD, and correlated strongly with histological steatosis (r = 0.73, P < 0.0001). None of the imaging tests was adequate enough to predict changes over time in histology. CONCLUSIONS: Despite its widespread use, liver US has several important limitations that healthcare providers should recognize, particularly because of its low sensitivity. Using a combination of echographic parameters, liver US showed a significant improvement in its diagnostic performance, but still was of limited value for monitoring treatment over time.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Fígado/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Obesidade/complicações , Sobrepeso/complicações , Biópsia , Feminino , Humanos , Fígado/patologia , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Curva ROC , Índice de Gravidade de Doença , UltrassonografiaRESUMO
Tissue biopsy following a pap test diagnosis of high grade squamous intraepithelial lesion (HSIL) sometimes fails to confirm the presence of a corresponding high grade cervical intraepithelial lesion (CIN 2-3), leading to confusion as to how best to manage the patient. It has been shown that these patients are still at higher risk for future detection of CIN 2-3 even if the initial biopsy fails to detect it. It has also been shown that immunohistochemical staining for p16INK4a can be reliably used as a surrogate marker for infection with high risk human papillomavirus in cervical samples, and that it can be used to enhance detection of CIN2-3 in cases where suspicion is high. To evaluate the use of p16INK4a staining in cases of HSIL which were not confirmed on initial biopsy, two pathologists rereviewed Pap and hematoxylin and eosin preparations from all such cases seen within the preceding 3 years. Immunohistochemical study for p16INK4a was performed and graded on representative sections. The results were tabulated and analyzed. Of the identified 596 HSIL Pap cases, 82% had HSIL on initial cervical specimens. Table 1 shows the 56 cases included in the study with graded and stratified p16INK4a results. On review of the p16INK4a slides, only 2 cases could be upgraded to HSIL/CIN2-3 from the original diagnosis. p16INK4a 2-3+ was expressed more frequently in cases initially interpreted on Pap as low-grade cervical lesion as compared with benign (24 of 35 cases). In the younger than 24-yr-old group p16 2-3+ reactivity was more frequent in benign and low-grade cervical lesion/CIN1 groups (benign: 3 of 5 cases, and CIN1: 6 of 8), and p16 negative reactivity was not seen. p16INK4a was graded 0-1+ more frequently in specimens interpreted as benign in the older than 25 yr olds (10 of 16 cases). The study suggests some diagnostic benefit from the use of p16INK4a immunohistochemical study on cervical specimens from women with a HSIL Pap test without HSIL/CIN2-3 on original hematoxylin and eosin review.
Assuntos
Biomarcadores Tumorais/análise , Inibidor p16 de Quinase Dependente de Ciclina/análise , Lesões Intraepiteliais Escamosas Cervicais/patologia , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Estudos Retrospectivos , Esfregaço Vaginal , Adulto JovemRESUMO
This study aimed to establish factors associated with delayed surgery in patients with proximal femoral fracture and to assess patients' health-related quality of life (HRQoL) after surgery including all-cause 6-months mortality. This was a single-center, observational, prospective cohort study that included patients with a proximal femur fracture. We described patients' HRQoL measured by EuroQoL (EQ-5D-5L and EQ-VAS) questionnaire and perioperative complications (including mortality) 6 months after surgery. We included 163 patients with a mean age of 80.5 years, the majority were women and 76.1% reported falling from their own height. The mean time between hospital admission and surgery was 8.3 days (SD 4.9 days) and the mean hospital stay was 13.5 days (SD 10.4 days). After adjustment, the principal factor associated with delayed surgery was adjournment in surgery authorization (3.7 days). EQ-5D-5L index values and the VAS score at 1 month after surgery were 0.489 and 61.1, at 3 months were 0.613 and 65.8, and at 6 months 0.662 and 66.7 respectively. Mortality at 6 months of follow-up was 11% (18 patients). In conclusion, administrative authorization was the strongest associated factor with delayed time from hospital admission to surgery. HRQoL of patients with a proximal femoral fracture improved 6 months after surgery.Trial registration: NCT04217642.
Assuntos
Fraturas Proximais do Fêmur , Humanos , Feminino , Masculino , Idoso de 80 Anos ou mais , Estudos Prospectivos , Qualidade de Vida , Acidentes por Quedas , HospitalizaçãoRESUMO
Abstract Hip fracture is one of the major public healthcare problems in elderly patients around the world, mainly because of the risk of falls and osteoporosis which are typical during this stage of life, and may be the cause for up to 36% of deaths among those affected. Its management in principle is surgical and the best results are achieved with patients undergoing surgery during the first 24 to 72 hours after the fracture. Any delays in surgery are mostly associated with decompensated personal pathological factors, delays in perioperative assessment, or in presurgical complementary tests; sometimes, the delays are the result of administrative formalities of the healthcare providers. These determining factors may affect both morbidity and mortality, and contribute to functional decline, disability, and reduced quality of life of these patients. A third party intervention is then necessary to improve the preventable factors that delay the osteosynthesis in these types of fractures, in addition to ensuring education, infrastructure, inputs, skilled human resources, and prompt referral of patients from the first level of care. Investigating this scenario and assessing the quality of life impact on these patients should be a priority.
Resumen La fractura de cadera representa uno de los problemas de salud pública más grandes en los pacientes ancianos en todo el mundo, principalmente, por el riesgo de caídas y la osteoporosis típicos en esta etapa de la vida, que puede causar la muerte de hasta el 36 % de los afectados; su manejo es en principio quirúrgico y los mejores resultados se presentan cuando se interviene en las primeras 24 a 72 horas después de la fractura. El retraso en la corrección quirúrgica está asociado principalmente a factores patológicos personales no compensados, demora en la valoración perioperatoria o en los estudios complementarios prequirúrgicos, o por trámites administrativos de las empresas prestadoras de servicios de salud. Estos determinantes pueden afectar la morbimortalidad y contribuir a un deterioro funcional, incapacidad y pérdida de la calidad de vida de estos pacientes. Se hace necesaria una intervención por parte de terceros para mejorar los factores prevenibles que retrasan la osteosíntesis de este tipo de fracturas; además, asegurar educación, infraestructura, insumos, talento humano capacitado y remisión rápida de pacientes desde el primer nivel de atención. Investigar en este escenario y evaluar los efectos en la calidad de vida de estos pacientes debería ser una prioridad.
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Operatórios/métodos , Tempo para o Tratamento , Fraturas do Quadril , Qualidade de Vida , Mortalidade , Fraturas Ósseas , Fraturas por Osteoporose , Complicações IntraoperatóriasRESUMO
The objective was to evaluate the effect of partial or total replacement of Tifton 85 hay with fresh or dehydrated spineless cactus on performance and body weight components of sheep. Thirty hair lambs, with 19 kg ± 0.35 kg initial weight, were randomly divided into five treatments, namely: Tifton 85 Hay (HA); Tifton 85 Hay + fresh spineless cactus (HAFC); Tifton 85 Hay + dehydrated spineless cactus (HADC); fresh spineless cactus (FC); dehydrated spineless cactus (DC). In addition to the spineless cactus and hay, the complete mixture contained soybean meal, mineral salt and limestone in all treatments. Animals were confined for 75 days and then slaughtered. The weight of body components was recorded. Dry matter intake, total digestible nutrients intake and voluntary water intake were higher (p 0.05) for the DC and HADC treatments. The average daily gain was 118 g day-1 and body weight at slaughter of 25.8 kg were not influenced (p > 0.05) by treatments. The cold carcass weight, rib eye area, weight and yield of the skin, liver, kidney and large intestine were higher (p 0.05) for the DC and HADC treatments. Partial or total replacement of Tifton 85 hay with fresh or dehydrated spineless cactus, in complete diets for sheep, increases the weight of the cold carcass and non-carcass components.(AU)
Objetivou-se avaliar o efeito da substituição parcial ou total do feno de Tifton 85 por palma forrageira in natura ou desidratada sobre o desempenho e componentes do peso corporal de ovinos. Foram distribuídos aleatoriamente 30 cordeiros deslanados, com peso vivo inicial de 19 kg ± 0,35 kg, em cinco tratamentos, a saber: feno de Tifton 85 (FE); feno de Tifton 85 + palma in natura (FEPA); feno de Tifton 85 + palma desidratada (FEPD); palma in natura (PA); palma desidratada (PD). Além da palma e feno ofertou-se, na forma de mistura completa, farelo de soja, sal mineral e calcário em todos os tratamentos. Os animais foram mantidos confinados durante 75 dias; decorridos esse período foram abatidos e tiveram os pesos dos componentes corporais registrados. O consumo de matéria seca, nutrientes digestíveis totais e ingestão voluntária de água foram maiores (p 0,05) para os tratamentos PD e FEPD. O ganho médio diário foi de 118 g dia-1 e o peso corporal ao abate de 25,8 kg e não foram influenciados (p > 0,05) pelos tratamentos. O peso de carcaça fria e área de olho de lombo foram menores (p 0,05) para dieta FE. A substituição parcial ou total do feno de Tifton 85 por palma forrageira (in natura ou desidratada) melhora o desempenho e as características de carcaça de ovinos.(AU)
Assuntos
Animais , Elaeis guineensis/análise , Elaeis guineensis/classificação , Ração Animal/efeitos adversos , Ração Animal/análise , Ração Animal , Ovinos/crescimento & desenvolvimento , Ovinos/metabolismo , Peso CorporalRESUMO
The objective was to evaluate the effect of partial or total replacement of Tifton 85 hay with fresh or dehydrated spineless cactus on performance and body weight components of sheep. Thirty hair lambs, with 19 kg ± 0.35 kg initial weight, were randomly divided into five treatments, namely: Tifton 85 Hay (HA); Tifton 85 Hay + fresh spineless cactus (HAFC); Tifton 85 Hay + dehydrated spineless cactus (HADC); fresh spineless cactus (FC); dehydrated spineless cactus (DC). In addition to the spineless cactus and hay, the complete mixture contained soybean meal, mineral salt and limestone in all treatments. Animals were confined for 75 days and then slaughtered. The weight of body components was recorded. Dry matter intake, total digestible nutrients intake and voluntary water intake were higher (p 0.05) for the DC and HADC treatments. The average daily gain was 118 g day-1 and body weight at slaughter of 25.8 kg were not influenced (p > 0.05) by treatments. The cold carcass weight, rib eye area, weight and yield of the skin, liver, kidney and large intestine were higher (p 0.05) for the DC and HADC treatments. Partial or total replacement of Tifton 85 hay with fresh or dehydrated spineless cactus, in complete diets for sheep, increases the weight of the cold carcass and non-carcass components.
Objetivou-se avaliar o efeito da substituição parcial ou total do feno de Tifton 85 por palma forrageira in natura ou desidratada sobre o desempenho e componentes do peso corporal de ovinos. Foram distribuídos aleatoriamente 30 cordeiros deslanados, com peso vivo inicial de 19 kg ± 0,35 kg, em cinco tratamentos, a saber: feno de Tifton 85 (FE); feno de Tifton 85 + palma in natura (FEPA); feno de Tifton 85 + palma desidratada (FEPD); palma in natura (PA); palma desidratada (PD). Além da palma e feno ofertou-se, na forma de mistura completa, farelo de soja, sal mineral e calcário em todos os tratamentos. Os animais foram mantidos confinados durante 75 dias; decorridos esse período foram abatidos e tiveram os pesos dos componentes corporais registrados. O consumo de matéria seca, nutrientes digestíveis totais e ingestão voluntária de água foram maiores (p 0,05) para os tratamentos PD e FEPD. O ganho médio diário foi de 118 g dia-1 e o peso corporal ao abate de 25,8 kg e não foram influenciados (p > 0,05) pelos tratamentos. O peso de carcaça fria e área de olho de lombo foram menores (p 0,05) para dieta FE. A substituição parcial ou total do feno de Tifton 85 por palma forrageira (in natura ou desidratada) melhora o desempenho e as características de carcaça de ovinos.
Assuntos
Animais , Elaeis guineensis/análise , Elaeis guineensis/classificação , Ração Animal , Ração Animal/análise , Ração Animal/efeitos adversos , Ovinos/crescimento & desenvolvimento , Ovinos/metabolismo , Peso CorporalRESUMO
Aunque hayan transcurrido 20 años desde el descubrimiento del VIH/SIDA esta epidemia sigue aumentando significativamente a pesar de las estrategias desarrolladas, incluyendo el descubrimiento de terapia antirretroviral efectiva. Una de las poblaciones vulnerables a esta infección son los niños de madres positivas para el virus de la inmunodeficiencia humana (VIH), que no sólo están expuestos a la infección sino también a quedar huérfanos, y con pocas opciones para subsistir. Existen muchos factores implicados en la transmisión vertical del VIH-1; dentro de ellos se destacan los virales, inmunogenéticos y los farmacológicos. La transmisión vertical del VIH-1 es mas frecuente durante el parto y la lactancia que durante el período intrauterino. Dentro de las medidas que se pueden tomar para disminuir la tasa de transmisión vertical se encuentran el control pre y postnatal, la terapia antiretroviral adecuada tanto para la madre como para el niño, la cesárea, el tratamiento de enfermedades de transmisión sexual (ETS), el uso de suplementos vitamínicos y la sustitución de la lactancia
Assuntos
Transmissão Vertical de Doenças Infecciosas , Infecções por HIV/transmissão , HIV , Fatores de RiscoRESUMO
La agammaglobulinemia ligada al cromosoma X (XLA) es una inmunodeficiencia primaria caracterizada por disminución de linfocitos B circulantes y por la reducción de los niveles plasmáticos de varios isotipos de inmunoglobulinas. Los individuos afectados, tienen mayor susceptibilidad de presentar infecciones bacterianas del tracto respiratorio, así como infecciones por enterovirus. En este reporte se describe la historia clínica de tres pacientes de sexo masculino vinculados al servicio clínico del grupo de inmunodeficiencias primarias de la Universidad de Antioquia, en quienes se estableció el diagnóstico de XLA. Gracias a esto los pacientes se beneficiaron de una terapéutica con gamaglobulina intravenosa, lo que ha mejorado sustancialmente su calidad de vida.
Assuntos
Imunoglobulinas , Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/genética , Síndromes de Imunodeficiência/imunologiaRESUMO
Introducción: la exposición repetida al virus de la inmunodeficiencia humana (VIH) no siempre llevan la infección, multiples factores de resistencia han sido propuestos, pero sólo una mutación, la delección de 32 pares de base (delta 32)en el gen que codifica por la molécula CCR5, confiere un alto grado de protección; esta molécula es el principal correceptor del virus: Objetivos: determinar la frecuencia de delta 32 en Medellín, Colombia y buscar otros polimorfismos en el gen ccr5 en individuos expuestos al VIH y seronegativos (ESNs). Materiales y métodos: la mutación delta 32 se determinó por la técnica de reacción en cadena de la polimerasa en 218 individuos: 29 seropositivos (SP), 39 ESN y 150 individuos de la población general (PG). Por medio de la técnica de polimorfismos conformacionales de cadena simple (SSCP) se buscaron otras mutaciones en el gen ccr5 en la población de ESNs. Resultados: la frecuencia del alelo delta 32 fué de 3.8 por ciento para ESN, 2.7 por ciento para PG y 1.7 por ciento para SP. Entre los ESNs se encontró el único genotipo homocigótico mutado (ccr5/ delta 32/delta 32), se encontro en el 5.3 por ciento de la PG y en 2.6 por ciento de SP y de ESNs. Las diferencias en las frecuencias alélicas y genotipicas entre los grupos no fueron estadísticamente significativas. La comparación entre las frecuencias genotípicas esperadas y observadas mostró que estas frecuencias eran significativamente diferentes en el grupo de ESNs. Lo que sugirió en forma indirecta, un efecto protector del geneotipo gemocigótico mutado en delta 32/delta 32. No se encontró ninguna otra mutación en el gen ccr5. Conclusión: la baja frecuencia del genotipo homocigótico mutado delta 32/delta 32y la ausencia de otras mutaciones en ccr5 en los ESNs sugierén la presencia de otros mecanismos de resitencia a la infección por VIH en nuestra población